Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

Employer Reference Pricing Lowers Prescription Drug Expenses

by

As payers and employers learn to counter significant increases of prescription drug expenses, reference pricing may hold the key to lowering drug spending and increasing consumer purchases of lower cost drugs, according to research published...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

by

Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics infrastructure, according to commentary published...

Tufts Health Plan Launches Four Medicaid ACO Partnerships

by

Tufts Health Plan has signed contracts to form Medicaid accountable care organizations (ACOs) with Atrius Health, Beth Israel Deaconess Care Organization, Cambridge Health Alliance, and Boston Children’s Hospital ACO, according to a press...

Stop-Loss Insurance a Growing Market Opportunity for Healthcare

by

Even though payers may experience higher total revenues on commercial self-insurance, stop-loss and third-party protected insurance revenues have been growing at a higher rate with stronger market stability according to market research from AM...

CMS: Payers Will Have More Time to File 2018 Health Plan Rates

by

Payers still debating how uncertainty over cost-sharing reduction (CSR) subsidies will alter their insurance prices now have more time to submit 2018 health plan rates, CMS announced in a letter to insurers. While the letter says there's...

Explaining Out-of-Pocket Costs May Ease Cancer Care Stress

by

Patients who are not prepared for the magnitude of their out-of-pocket costs for cancer care are more likely to be distressed and less likely to pay their bills than other individuals, according to a research letter published in JAMA Oncology....

As ACA Debate Lingers, Non-Marketplace Members Present Risks

by

While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and wealthier,...

Payers May Be Neglecting a Growing Medicare Advantage Market

by

Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Can Healthcare Price Transparency Tools Cut Costs for Payers?

by

As out-of-pocket costs for patients continue to rise alongside payer spending on services, many health insurance companies are turning to online price transparency tools to help beneficiaries decide how to purchase low cost, high quality care....

BCBS Minnesota Launches Prediabetes Prevention Campaign

by

Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on helping individuals...

Employers Expect 2018 Benefit Costs to Rise $14K Per Employee

by

Large employers will have to rely on healthcare delivery innovations and cost management strategies as employers face a 5 percent rise in the cost of providing employee healthcare benefits, according to a National Business Group on Health (NBGH)...

Anthem to Withdraw from ACA Individual Market Exchanges in NV

by

Anthem BlueCross BlueShield (BCBS) will completely withdraw from Nevada’s ACA exchange for individual health plans in 2018, the health payer announced on Monday. The payer’s decision follows discussion with state leaders and regulators....

Low Medicaid Payment Rates Decrease Residential Care Quality

by

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

by

A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs, the group announced in a joint statement....

Latest Earnings Reports Show State of Health Payers in 2017

by

At the half-year mark, payers have a good sense of how well their efforts to promote value-based care have fared and the opportunity to make the necessary adjusts where they have not. As part of the business-facing side of value-based care, payers...

CMS Approves State Capitated Medicaid Program in Florida

by

Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Medicaid Tops Private Insurance in Consumer Satisfaction KPIs

by

Medicaid critics have argued that enrollees are not receiving adequate care under the program, but recent consumer surveys indicate that beneficiaries are highly satisfied with their options.   According to a new J.D. Power poll, Medicaid...

Employer Cost Management Strategies Combat High Insurance Costs

by

Employers expect healthcare spending to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017, according to a Willis Towers Watson survey. The continued rise in costs has turned health cost management as a top employer concern,...

Socioeconomic Data Improves Public Health, Payer Programs

by

CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

Anthem Blue Cross Engages in Medicare Advantage Risk-Sharing

by

Anthem Blue Cross and America's Health Plan (AHP) have announced a risk sharing partnership aimed at improving services for Medicare Advantage beneficiaries in California. AHP and Anthem view the partnership as a gateway for promoting value-based...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks